Stepwise Approach to Asthma Treatment by Age Group
When the Expert Panel Guidelines were updated in 2007, one of the changes was an emphasis on modifying the treatment approach for kids with asthma, based on their age group. The reason for this is based on a few factors. First of all, kids of different age groups may respond differently to medications or require them to be given differently, such as nebulizer vs. inhaler. Secondly, scientific evidence proving safety and effectiveness of asthma medications is lacking in younger age groups. Third, lung function can not be assessed easily in younger age groups, making it harder to measure how well a drug is working. Asthma wheezing types may also vary by age group, and there may be other influencing factors as well.

In general, daily, long–term asthma controller medicine is recommended for both of the age groups below. Depending on the degree of control, medication frequency and/or dosage may be stepped up to improve control. Now, let’s look at each age group separately:

• Age 0 to 4 years
  Daily, long–term control therapy is recommended in this age group. It is aimed at reducing risk of asthma attacks and airway impairment in kids who had four or more episodes of wheezing in the past year that lasted more than 1 day and affected sleep AND who have risk factors for developing persistent asthma. It should also be considered for reducing impairment in infants and young children who consistently require symptomatic treatment more than 2 days per week for a period of more than 4 weeks. Thirdly, controller medications may be used in infants and young children who have a second asthma flare–up needing oral steroids within 6 months to reduce their risk. Finally, asthma controller medicines may be used during seasons of increased risk, in kids who have had problems in the past, namely in relation to respiratory infections, the most common trigger of asthma symptoms in young children.
  In these infants and young children, the decision to add, or step up, treatment will be based mainly on severity and frequency of observed symptoms.
• Age 5 to 11 years
  In kids this age, daily long–term controller therapy is recommended when the kids have been classified as having persistent asthma. At this age, the doctor weighs any possible risks of taking long–term asthma medicines, such as delayed growth, against the risks of not treating asthma. Studies have shown that the benefits definitely outweigh the relatively small risks, in most cases.

In this age group, the decision to step up treatment is based on the following

• Symptoms, both in terms of frequency and severity.
• Asthma control scores (if available), which are simply a measure of the degree of control, based on tested survey tools that quantify various factors to come up with a score.
• Pulmonary function testing.

To some extent, the treatment of asthma in children (and adults) is somewhat of a trial and error process. The goal is always to give the least medicine necessary to keep symptoms under control. When control is not attained, however, doctors will first evaluate whether the asthma medication is being given correctly. This includes following exact instructions for the dosage, frequency and time of day of the medicine. It also includes looking at inhaler or nebulizer technique, as using both in kids can be challenging at times.

The doctor will also consider whether other health problems, such as sinusitis, may be interfering with asthma control. And finally, efforts at avoiding environmental triggers must be looked at. When a child continues to come into daily contact with triggers, asthma control will be challenged. It should be emphasized too that every child should have a written, personalized Asthma Action Plan that guides parents on a day to day basis with managing their child’s asthma.

When stepping up treatment, or addressing the other factors discussed above, doesn’t improve the child’s health status, then a referral to an asthma specialty doctor is strongly encouraged, particularly in the presence of any of the following conditions:

• Control is difficult to achieve.
• A child in the 0 to 4 years age group requires step 3 or higher care.
• A child in the 5 to 11 years age group required step 4 or higher care.
• The child has an asthma flare that requires hospitalization.
• Allergy tests or allergy shots are to be considered, due to suspicions of allergic factors.

Physician Follow–up Care for Kids With Asthma
Once control has been achieved, the Expert Panel still recommends that kids be seen by their doctors every 1 to 6 months. If a future step–down in treatment is planned, then the child should be seen at 3–month intervals until this occurs. Step–down should be considered if a child has been under control for at least 3 months.

Source: www.asthma.about.com